More and more products containing cannabidiol (CBD) that manufacturers claim have therapeutic and medical benefits are popping up in stores and online. Unfortunately, consumers don’t always understand they should take such claims with a grain of salt. That’s why healthcare providers need to be up-to-date on expert opinion regarding the effects of CBD.
Why are CBD Products on the Rise?
To start, it may be helpful to know why CBD seems to be suddenly all the rage. Increased cultural acceptance of marijuana (the plant CBD is derived from), changing state laws and the 2018 Farm Bill have all played a role, according to the U.S. Food & Drug Administration. In December, the Farm Bill made any cannabis or cannabis derivates with less than 0.3 percent THC no longer a “controlled substance.” This applies to most CBD products.
Since then, the FDA has targeted several companies, such as Curaleaf and Nutra Pure, for marketing CBD products as treatments for anxiety, chronic pain and even cancer without any evidence. There are still outstanding questions about the safety of CBD, but perhaps the biggest risk of these marketers’ actions is that they may delay patients with serious illnesses in seeking medical attention.
What CBD Products Are Approved by the FDA?
In total, the FDA has approved three medications containing synthetic versions of THC (the psychoactive component of cannabis): Marinol, Syndros and Cesamet. The active ingredient in the first two is dronabinol, a synthetic delta-9-THC. Marinol and Syndros are often used to treat weight loss in anorexic and AIDS patients. Cesamet contains nabilone, which has a similar chemical structure to THC, and minimizes nausea caused by chemotherapy.
The FDA has also approved one drug derived from actual cannabis. Epidiolex contains a purified version of CBD and is used to treat seizures associated with Lennox-Gastaut (LGS) and Dravet syndromes in patients age 2 and older.
No other medical or therapeutic uses of CBD have been approved by the FDA. The agency also has not approved a marketing application for cannabis for the treatment of any disease or condition.
What Should Clinicians Tell Patients About Using Non-FDA-Approved CBD Products?
As STAT News reports, many NPs, PAs and physicians are struggling to navigate the strange, new world of CBD. On one hand, strictly telling patients “no” rarely works. On the other, some clinicians believe Epidiolex‘s success means CBD likely has medical benefits — especially if it gives patients with chronic or life-threatening conditions something that’s impossible to prescribe, hope.
1. The FDA has not approved any CBD products (besides the aforementioned prescription drugs) as an effective treatment for medical conditions.
2. Most, if not all, CBD companies’ claims that their products have medical benefits, especially for serious and life-threatening conditions like cancer, are unsubstantiated.
3. CBD companies primarily sell their products as supplements and not medication, which means their safety and contents are not regulated. Investigations have found many CBD products don’t contain the actual amount of CBD advertised. Some even contain contaminants, such as pesticides and heavy metals.
4. CBD can increase levels of the blood thinner coumadin and raise levels of other medications in one’s blood. Advise patients to consult a medical professional before using CBD to assure it doesn’t affect any other medications they may be taking.
5. The medical community has not come to a consensus about the most effective therapeutic dose of CBD for any particular medical condition.
6. The strongest medical evidence supporting the benefits of CBD are its effects on childhood epilepsy, in particular, Dravet syndrome and LGS. Numerous studies show CBD can reduce the number of seizures and in some cases stop them altogether.
7. Side effects of CBD include nausea, fatigue and irritability.
8. If your patients do decide to use CBD, ask them to share with you what product they’re taking, how much, how often and its effects. Consumers can report adverse effects through the FDA’s MedWatch program.